ArticlePractical radiation oncology2026
Omission of Sentinel Lymph Node Biopsy Among Women Aged 50 to 70 With Early-Stage Breast Cancer: Applying an Updated ASCO Guideline to a Real-World Population.
Article in Practical radiation oncology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
purposeRecent practice-changing guidelines from the American Society of Clinical Oncology (ASCO) recommend the omission of sentinel lymph node biopsy (SLNB) in patients over the age of 50 with early-stage breast cancer. We aimed to evaluate the association of clinicopathologic factors with sentinel lymph node positivity (SLN+) and the association of SLN+ with adjuvant therapy recommendation in this population. METHODS AND MATERIALS: A single-institution retrospective cohort study of patients aged 50 to 70 years with early-stage invasive breast cancer (cT1N0, grade 1-2, estrogen receptor-positive, human epidermal growth factor receptor 2 negative (HER2-)) between 2022 and 2024 who underwent SLNB. Preoperative axillary ultrasound was not required. The univariate relationship between covariates and SLN+ was assessed using Fisher's exact test or logistic regression, followed by multivariable logistic regression. Fisher's exact test was also used to evaluate the relationship between SLN+ and receipt of adjuvant therapy. Two-year disease-free survival was estimated using the Kaplan-Meier method.
resultsAmong 268 patients meeting the new ASCO Guideline criteria, the average age was 62 years (SD, 5.1). The majority had ductal histology (81.0%), pathologic T1 disease (94.8%), and grade 1 disease (51.5%). Adjuvant therapy included endocrine therapy (86.9%), whole breast radiation therapy (WBRT) (73.1%), partial breast radiation therapy (19.4%), chemotherapy (5.6%), and cyclin-dependent kinase 4/6 inhibitor (0.7%). SLN was positive in 15 (5.6%) patients (8 pN1mi, 7 pN1a). Factors statistically significantly associated with SLN+ included pathologic tumor category (P = .006) and 21-gene recurrence score (P < .001). An SLN+ result potentially impacted adjuvant recommendations for 11 patients (4.1%): 1 with a low 21-gene recurrence score received chemotherapy, 1 received a cyclin-dependent kinase 4/6 inhibitor, and 9 were eligible for partial breast radiation and received WBRT. With a median follow-up of 24.0 months, 2-year disease-free survival was 98% (95% CI, 96.1%-99.9%).
conclusionsIn patients aged 50 to 70 years meeting the 2025 ASCO Guideline for SLNB omission, SLN+ was infrequent. Adjuvant treatment recommendations were unchanged in >95% of patients, due in part to information from other factors, such as recurrence score.
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